Treatment of Type IIIb Pancreatic Injury

Abstract

Objectives and Methods: Treatment of traumatic type IIIb pancreatic injury is a clinically challenging problem. We examined reviewed 10 cases of type IIIb pancreatic injury managed at our institution. Diagnosis and Treatments: In cases where the pancreatic injury was severe, we attempted stent insertion into the pancreatic duct by ERP. Results: We performed ERP in three cases and inserted a stent in two cases. For the five cases with pancreatic body and tail injury, pancreas body and tail excision was performed. Extensive pancreatosplenectomy, bile drainage+pancreatic duct stenting, and the Letton&Wilson procedure were performed in one case each of the three patients with pancreatic head injury. PD was performed in two IIIb+D cases and one case was lost to MOF. A stent could confirm even the example which the crush of the pancreas was strong in operation, and identification and suture/ligation of the pancreatic duct were possible in all cases. Six cases showed pancreatic juice leakage after the operation, which was relieved by conservative treatment in all six cases. Conclusions: Preoperative ERP was useful for grasping the site and type of injury in patients with type IIIb pancreatic injury. In the strong case of the pancreas crush Even in cases with severe crush injury of the pancreas, insertion of a stent was effective for identification of the pancreatic duct. Damage control surgery may be recommended for poor-risk cases of pancreatic type IIIb injury.